Getting traditional long-term care insurance at age 90 is extremely unlikely. Most major insurers stop issuing new policies well before that age, and the few companies that consider applicants over 80 impose strict health requirements that very few 90-year-olds can meet. That doesn’t mean there are no options for covering care costs at this age, but a standard long-term care policy almost certainly isn’t one of them.
Why Traditional Policies Are Out of Reach
Long-term care insurers use medical underwriting to screen out applicants who are likely to need care soon. At 90, the odds of needing help with daily activities like bathing, dressing, or eating are high enough that most companies won’t take the risk. The conditions that commonly disqualify applicants, including diabetes, stroke history, difficulty with any daily self-care task, heart problems, and even mild memory issues, are widespread among people in their 90s.
Research published in Health Affairs found that difficulty with even one daily living activity, a stroke history, and diabetes were the strongest disqualifiers in underwriting decisions. A low score on a simple word-recall test also significantly reduced the chance of approval. At 90, the likelihood of having at least one of these conditions is very high.
Even among applicants in their 80s who do qualify, the math is punishing. The American Association for Long-Term Care Insurance reports that a single person approved at age 85 can expect to pay around $11,000 per year for a policy that would pay out roughly $164,000 in total benefits. A couple would pay $20,000 to $22,000 annually for similar coverage. At 90, premiums would be even steeper for even less benefit, which is one reason insurers simply stop offering policies at that point.
Insurance experts now recommend shopping for long-term care coverage in your late 40s or 50s. Even waiting until your early 60s, once considered reasonable, is now seen as pushing it.
What About Short-Term Care Insurance?
Short-term care insurance covers a shorter window of care, typically up to one year rather than the multi-year coverage of traditional policies. However, these plans also have age limits. UnitedHealthcare’s short-term medical plans, for example, require applicants to be healthy and under 65. This category of product is not a viable path for a 90-year-old.
Using an Existing Life Insurance Policy
If the 90-year-old already holds a life insurance policy, that asset may be more useful than a new insurance purchase. There are several ways to convert life insurance into care funding.
- Accelerated death benefit: Many life insurance policies include a provision that allows tax-free cash advances while the policyholder is still alive. You can typically access this benefit if you live permanently in a nursing home, need extended long-term care, are terminally ill, or have a life-threatening diagnosis. The amount is subtracted from what beneficiaries receive after death.
- Life settlement: This involves selling a life insurance policy to a third party for its current cash value. It’s generally available to women 74 and older and men 70 and older, so a 90-year-old would qualify on the age front. The proceeds are taxable but can be used for anything, including paying for care.
- Viatical settlement: If the person is terminally ill with a life expectancy of two years or less, they can sell their policy to an insurance company for a percentage of the death benefit. The payout is tax-free, though companies decline more than half of applicants.
All three options reduce or eliminate the death benefit that would otherwise pass to heirs. But for someone facing immediate care costs, redirecting that money toward their own care is often the practical choice.
Medicaid Coverage for Long-Term Care
Medicaid is the largest payer of long-term care in the United States, and it has no upper age limit. The catch is financial: you must meet strict income and asset limits to qualify. Residents of Medicaid-funded nursing homes can generally have monthly income up to $2,982 (as of 2026), but nearly all of that income goes directly toward care costs. Each person keeps only a small personal needs allowance, which ranges from $30 to $200 per month depending on the state.
Qualifying for Medicaid often requires spending down assets first. For people with significant savings or property, this process can be complicated and is worth discussing with an elder law attorney. Medicaid planning strategies exist, but they work best when started well in advance of needing care. Some asset transfers made within five years of applying for Medicaid can trigger penalty periods that delay eligibility.
VA Benefits for Veterans
Veterans and surviving spouses may qualify for the Aid and Attendance benefit, which provides additional monthly payments on top of a VA pension to help cover care costs. To be eligible, at least one of the following must apply: you need help with daily activities like bathing, feeding, or dressing; you spend a large portion of the day in bed due to illness; you’re in a nursing home because of a disability-related loss of mental or physical ability; or your eyesight is severely limited.
There’s no upper age limit for Aid and Attendance, and the benefit can be used to pay for care at home, in an assisted living facility, or in a nursing home. The application process can take several months, so it’s worth starting early if this applies to your situation.
Paying Out of Pocket
For a 90-year-old who doesn’t qualify for Medicaid and doesn’t have a life insurance policy to leverage, private pay is often the remaining option. The national median cost of a private room in a nursing home exceeds $100,000 per year, and home health aide services typically run $60,000 or more annually. These numbers vary significantly by state and region.
Some families piece together coverage from multiple sources: personal savings for initial costs, a life insurance conversion for a bridge period, and eventually Medicaid once assets are spent down. Others use a reverse mortgage on a home to generate cash flow. Each approach has tradeoffs, and the right combination depends on the person’s health, assets, family situation, and the type of care they need.
The reality at 90 is that the window for insurance-based solutions has closed, but the need for a financial plan hasn’t. The most productive step is usually a consultation with an elder law attorney or a financial planner who specializes in aging, someone who can map out what resources are available and how to structure them to cover the longest possible period of care.